The Screening Of Early Renal Damage In Hypertensive Patients And The Effects Of Drug Intervention And Its Relationship With The Plasma Arginine Vasopressin And Nitric Oxide

Background and objective Hypertension is the most common cardiovascular disease in our country, its prevalence rate is higher than 18.8%, hypertension can lead to cardiac, cerebrovascular and kidney damage, it is one of the major harmful diseases to human health.With the deepening of home and abroad medical research and people's higher demands of health and life, the diagnostic evaluation of patients with hypertension and treatment concept has been updated, the purpose of treatment for hypertensive patients has gradually shifted from preventing the incident of forward end to early prevention of kidney damage, delaying the small artery and atherosclerotic vascular disease of the development, improving the quality of life, prolonging life.The kidney damage is one of hypertension target organ damage perform ance, after the kidney suffers injury, intensifies hypertension, forming a vicious circle microalbuminuria (MA) is hypertension early time kidney harm evaluating indicator, in recent years received more and more attenti on.Therefore, at present, scholars at home and abroad continuously explore better treatment options to effectively control high blood pressure and to reversed, reduce its complications,protect target organ.Amlodipine is a long-acting dihydropyridine calcium antagonists, blocking calcium from myocardial and vascular smooth muscle cell membrane into the cells by the calcium ion channels, relaxing vascular smooth muscle directly, expanding peripheral small arteries, so that peripheral resistance decreased and blood pressure achieved results.Oral absorption is slow, taking amlodipine can reduce blood pressure significantly regardless of day or night.Telmisartan is a new non-peptide angiotensinⅡAT1 receptor antagonist, it is competitive with angiotensinⅡAT1 blockers, thereby antagonist of angiotensinⅡ-induced vasoconstr iction, sympathetic excitement, increased aldosterone secretion, water retention,etc.it has a stable antihypertensi- ve effect,and had less adverse reactions, is a relatively new type of ideal antihypertensive drugs.At present, the two drugs are widely used in the treatment of hyperte nsion,but the control rate of hypertension is not satisfied.However, whether the two combinati on the two drugs can improve rates of hypertension control,reduce MA, is to be considered.In this study, amlodipine, telmisartan or telmisartan+amlodipine are severed in mild to moderate hypertensive patients with MA, observing the effect of the different drugs groups on blood pressure and MA,NAG,TRF, and exploring the change of arginine vasopressin (AVP) and nitric oxide (NO) and its relationship to the therapeutic results in patients with essential hypertension, designed to provides the new evidence for kidney protection of hypertension, provide effective treatment and indicators of efficacy for hypertension treatment.METHODS①The screening of early renal damage in hypertensive patients: according to the diagnostic criteria of 2005 "China's prevention and treatment guidelines for hypertension",from December 2007 to June 2008 survey of non-specific diagnosis of diabetes mellitus in patients with essential hypertension, all of cardiovascular medicine or medical treatment of hypertensive patients in this study can be used as the survey,by physical examination and necessary laboratory tests to exclude secondary hypertension; the total cases are 500.②MA screening : MA was detected in 500 patients with essential hypertension, calculate the positive rate, and then screened to meet the inclusion criteria of this study of patients, detection of its urinary NAG and TRF.③MA intervention: collect mild to moderate hypertensive patients 60 cases conforms to the selected standard, hypertensive patients who currently take antihypertensive drugs disable all anti-hypertensive drugs, and switch to study drugs after two weeks of the elution period , new cases who did not take antihypertensive drugs were directly selected , randomly divided into amlodipine group (20 cases); telmisartan group (20 cases); amlodipine+ telmisartan group (20 cases);④MA is measured by semiquantitative determination, Plasma AVP andNO in patients with essential hypertension were measured by RIA and colorimetric method, before and after treatment .RESULTS①MA were detected in 500 cases of mild to moderate hypertension , the results showed that 172(34.4%) cases of patients with positive result, of which, 79 cases are male (45.93%), 93 cases are female patients (54.07%), 97 cases (56.4%) over the age of 60, 75 cases (43.6%) lower the age of 60. Re-screened to meet inclusion criteria of this study , for a total of 60 cases, average age is 52.60±3.7 years old. 29 cases are male patients (48%), 31 cases are female patients (52%).SBP and DBP of patients older than 60 respectively compared with the SBP and DBP of patients lower than 60 ,there is no significant difference (P>0.05).②In 172 cases,the average content of MA is (76.59±3.26)mg /L, in which, the average levels of MA in mild hypertensive patients is (43.28±1.33)mg/L, in moderate hypertensive patients is (88.12±2.71)mg/L, significantly higher than that in patients with mild hypertension, has very significant difference (P<0.01),the average levels of MA in severe hypertensive patients is(96.37±3.68)mg/L, significantly higher than that in patients with mild hypertension (P<0.01) and moderate hypertension (P<0.05).③MA,urine NAG, urine TRF were detected in 60 cases of mild to moderate hypertensive patients,the average content respectively were (77.43±5.62) mg/L,(55.28±3.57)U/L,(12.39±1.28)mg/L.normal of MA, urine NAG, urine TRF respectively were<20mg/L,<15U /L, <2mg/L, the MA, urine NAG and urine TRF in 60 hypertensive patients with were significantly higher than normal(P<0.01).④The pre- trea tment plasma MA content of amlodipine group, telmisartan group and amlodipine+telmisartan group respectively were: (77.14±4.98) mg/L,(75.38±5.84) mg/L and (79.77±6.03) mg/L; after six months treatment, its contents respectively were: (9.69±2.81) mg/L,(7.79±4.00) mg/L and (4.62±2.43) mg/L. The MA content of patients in each group decreased significantly (P<0.05) after treatment , Amlodipine + telmisartan group were lower than amlodipine group and the telmisartan group, and the difference has statistical significance (P<0.05), amlodipin e group in compare with telmisartan group showed no significant difference (P>0.05).⑤The pre-treatment plasma NAG content of amlodipine group, telmisartan group and amlodipine +telmisartan group respectively were(53.88±3.71)U/L,(54.1±4.29)U/L及(57.85±2.72)U/L; after six months treatment, its contents respectively were (10.11±2.43)U/L,(11.89±3.85)U/L及(9.51±3.67)U/L. The NAG content of patients in each group decreased significantly (P<0.05) after treatment, Amlodipine + telmisartan group were lower than amlodipine group and the telmisartan group, and the difference has statistical significance (P<0.05), amlodipine group in compare with telmisartan group showed no significant difference (P>0.05).⑥The pre-treatment plasma TRF content of amlodipine group, telmisartan group and amlodipine+telmisartan group respectively were(11.33±1.12)mg/L,(11.27±1.35)mg/L及(14.58±1.37)mg/L; after six months treatment, its contents respectively were (3.37±0.89)mg/L,(3.89±0.63) mg/L及(2.54±1.07)mg/L. The TRF content of patients in each group decreas ed significantly (P<0.05) after treatment, Amlodipine + telmi sartan group were lower than amlodipine group and the telmisartan group, and the difference has statistical significance (P<0.05), amlodipine group in compare with telmisartan group showed no significant difference (P>0.05).⑦The pre-treatment systolic blood pressure(SBP) of amlodipine group, telmisartan group and amlodipine + telmisartan group respectively were:146.31±3.15mmHg, 145.92±2.71mmHg and 146.00±2.42mmHg; diastolic pressur(eDBP)respectively were:93.77±2.39 mmHg,92.54±2.68mmHg, 94.93±1.15 mmHg. after six months treatment, the SBP respectively were:126.69±1.74mmHg, 126.08±1.52mmHg and 102.71±2.20mmHg; DBP respectively were: 80.76±1.13 mmHg, 81.00±0.80 mmHg, 76.11±1.36mmHg. Both systolic and diastolic blood pressure of each group patients decreased significantly, and the difference has statistical significance (P<0.05); the SBP and DBP of amlodipine + telmisartan group were lower than amlodipine group and the telmisartan group, and the difference has statistical significance (P<0.05),amlodipine group in compare with telmisartan group showed no significant difference (P>0.05).⑧After one month and two months treatment the blood pressure success rate of amlodipine + telmisartan group were higher than amlodipine group and the telmisartan group, and the difference has statistical significance (P<0.05), amlodipine group in compare with telmisartan group showed no significant difference (P>0.05).⑨The pretreatment plasma NO content of amlodipine group, telmisartan group and amlodipine+ telmisartan group respectively were: 12.77±0.23umol/L,11.68±0.35 umol/L and 10.09±1.04umol/L; after six months treatment, its contents respectively were: 18.50±2.14umol/L,19.07±1.96umol/L and 25.47±1.84umol/L. The plasma NO content of patients in each group increased significantly (P<0.05) after treatment , Amlodipine + telmisartan group were higher than amlodipine group and the telmisartan group, and the difference has statistical significance (P<0.05)., amlodipine group in compare with telmisartan group showed no significant difference ( P>0.05).⑩The pre-treatment plasma AVP content of amlodipine group, telmisartan group and amlodipine+ telmisartan group respectively were: 34.71±4.36ng/L,33.07±3.77ng/L and 35.06±4.12ng/L; after six months treatment, its contents respectively were:22.35±2.71ng/L,24.12±3.11ng/L and 17.98±1.79ng/L. The plasma AVP content of patients in each group decreased significantly (P<0.05) after treatment, Amlodipine+ telmisartan group were lower than amlodipine group and telmisartan group, and the difference has statistical significance (P<0.05), amlodipine group in compare with telmisartan group showed no significant difference( P>0.05); correlation analysis of plasma NO and AVP content showed that patients with increased plasma NO,plasma AVP decreased the two was negatively correlated(r =-0.49, P<0.01).CONCLUSION①MA of mild to moderate hypertensive patients have increased, suggesting that MA can be used as signal of early kidney damage of hypertention.②MA in moderate and severe hypertensive patients were significantly higher than that of mild hypertensive patients, suggusting MA increased with the degree of blood pressure.③amlodipine group, telmisartan group and amlodipine+ telmisartan group can effectively reduced MA,NAG,TRF, but the amlodipine + telmisartan group has a better effect. suggesting that amlodipine, telmisartan has the protection of kidney function.④Amlodipine group, telmisartan group and amlodipine+telmisartan group can effectively control blood pressure, but the amlodipine+telmisartan group has a better drop pressure effect.⑤Amlodipine group, telmisartan group and amlodipine+ telmisartan group can reduce blood pressure significantly simultaneously accompanied by plasma AVP content decreased and plasma NO content increased, amlodipine+ telmisartan group effect more visible, suggesting that the AVP and NO participated in the occurrence and development of hypertension, both can be used as indicators of hypertension observed.In conclusion, MA of mild to moderate hypertensive patients have increased, suggesting that MA can be used as signal of early kidney damage of hypertention. Detection of MA is a simple and non-invasive testing methods, detection of the content of MA in patients with hypertension has important significance to the early glomerular, tubular damage ,which can provide the basis for the integrated treatment of early renal artery damage prevent or delay kidney damage in patients with hypertension;MA in moderate and severe hypertensive patients were significantly higher than that of mild hypertensive patients, suggusting MA increased with the degree of blood pressure.amlodipine group, telmisartan group and amlodipine+telmisartan group can effectively control blood pressure, but the amlodipine+telmisartan group have a better effect, and with no serious adverse reactions. This provide an important method of treatment.for effectively control hypertension. All of the three groups can reduced MA, but the combined group has a better effect, the joint of the two has a synergy effect,and can provide better renal protection..In addition, the amlodipine group, telmisartan group and amlodipine+ telmisartan group can reduce blood pressure significantly simultaneously accompanied by plasma AVP content decreased and plasma NO content increased, amlodipine+ telmisartan group effect more visible, suggesting that the AVP and NO participated in the occurrence and development of hypertension, the imbalance of the two may be an important mechanism for hypertension, Therefore considering the two can be used as indicators of hypertension evaluated.